Haiti After the Earthquake (65 page)

39
Estimates of the amount of debris have ranged between 10 and 20 million cubic meters. Katz. “AP Impact: Haiti Still Waiting for Pledged U.S. Aid.”

40
The Associated Press reported that of 1,583 U.S. contracts for Haiti relief efforts made by December, only 20 went to Haitian companies (worth $4.3 million out of $267 million). Most went to beltway contractors, including one quarter disbursed through a no-bid process that didn't include Haitian participants. See Martha Mendoza. “Would-Be Haitian Contractors Miss Out on Aid.” Associated Press (December 12, 2010). Available: http://news.yahoo.com/s/ap/20101212/ap_on_re_us/cb_haiti_outsourcing_aid_1.

41
When we gathered to lay the cornerstone of the new hospital, Ann read a letter I'd sent her in March of 1989: “When we last spoke, you were teetering between business and art. If business won out, would you please help me to build a hospital for the poor in Haiti? If you stayed with art, would you please send us a painting to cheer up our patients?” We are grateful she became an architect.

42
For information on the Mirebalais hospital, including recent updates about
construction and videos onsite, see
http://www.pih.org/six-months/subject/mirebalais-teaching-hospital
(accessed April 15, 2011).

1
P. Lawrence et al. “The Water Poverty Index.”

2
Cholera thrives in the poor sanitation and water conditions of refugee camps. After the genocide in Rwanda, millions of refugees, including most surviving
génocidaires
, streamed across the Congolese border and took shelter in the region around Goma. Before long, they were housed and fed by the humanitarian machine that now follows conflict as surely as day follows night. Cholera exploded in those camps, drawing ever greater numbers of humanitarian groups to the region. For more on this episode, see Linda Polman.
The Crisis Caravan,
chapter 1.

3
Acute Watery Diarrhea and Cholera: Haiti Pre-decision Brief for Public Health Action.
CDC (2010). Available:
http://www.bt.cdc.gov/disasters/earthquakes/haiti/waterydiarrhea_pre-decision_brief.asp
(accessed April 15, 2011).

4
Farmer et al. “Unjust Embargo of Aid for Haiti.”

5
For an extended discussion of the effect of the aid embargo on Haiti, see the 2008 report by the Center for Human Rights and Global Justice and the Global Justice Clinic at New York University's School of Law, Partners In Health, Zanmi Lasante, and the Robert F. Kennedy Center for Justice and Human Rights.
Wòch nan Soley: The Denial of the Right to Water in Haiti.
Available:
www.pih.org/page/-/reports/Haiti_Report_FINAL.pdf
(accessed April 15, 2011).

6
Farmer.
AIDS and Accusation.

7
Karen McCarthy Brown. “Systematic Remembering, Systematic Forgetting: Ogou in Haiti.” In
Africa's Ogun: Old World and New
. Sandra Barnes, ed. (Bloomington: Indiana University Press, 1989), p. 67. This topic is more fully explored in Alfred Métraux's classic study,
Haitian Voodoo
. Métraux traces the lineage of modern Haitian sorcery accusations to the same source: “Man is never cruel and unjust with impunity: the anxiety which grows in the minds of those who abuse power often takes the form of imaginary terrors and demented obsessions. The master maltreated his slave, but feared his hatred. He treated him like a beast of burden but dreaded the occult powers which he imputed to him. And the greater the subjugation of the Black, the more he inspired fear; that ubiquitous fear which shows in the records of the period and which solidified in that obsession with poison, which throughout the eighteenth century, was the cause of so many atrocities. Perhaps certain slaves did revenge themselves on their tyrants in this way—such a thing is possible and even probable—but the fear which reigned in the plantations had its source in deeper recesses of the soul: it was the witchcraft of remote and mysterious Africa which troubled the sleep of people in ‘the big house.'” Alfred Métraux.
Haitian Voodoo.
Hugo Charteris, trans. (New York: Schocken, 1972), p. 15.

8
E. Mintz and R. Guerrant. “A Lion in Our Village—the Unconscionable Tragedy of Cholera in Africa.”
N
ew
England Journal of Medicine
360 (2009): 1060–1063.

9
Randal Archibold. “Cholera Moves into Beleaguered Haitian Capital.”
New York Times
(November 9, 2010). Available:
http://www.nytimes.com/2010/11/10/world/americas/10haiti.html
(accessed April 15, 2011).

10
Pan American Health Organization. “Health Cluster Bulletin: Cholera Outbreak in Haiti—#15.” (January 21, 2011). Available:
http://new.paho.org/blogs/haiti/?p=1739
(accessed April 15, 2011).

11
Jonathan Katz. “Cholera Confirmed for Resident of Haiti's Capital.” Associated Press (November 9, 2010). Available:
http://www.physorg.com/news/2010-11-cholera-resident-haiti-capital.html
(accessed April 15, 2011).

12
Ibid.

13
My visit there eleven months earlier, with Luis-Alberto Moreno, the president of the Inter-American Development Bank, and our families, was designed to showcase our efforts with the Haitian public health sector in Lascahobas and, thus, to signal the potential for a similar partnership in Mirebalais, the closest town. None of us would ever have imagined that the two words, Nepal and Mirebalais, would come to have such significance less than a year later—although we should have. As noted twenty years ago, there is, in a global economy, no reason to believe that our pathogens will not be shared as freely as our products, our profits, and our losses. See P. Farmer. “The Exotic and the Mundane: Human Immunodeficiency Virus in Haiti.”
Human Nature
1, 4 (1990): 415–446.

14
Jonathan Katz. “UN Worries Its Troops Caused Cholera in Haiti.” Associated Press (November 20, 2010). Available:
http://www.msnbc.msn.com/id/40280944/ns/health/
(accessed April 15, 2011).

15
Ibid.

16
Some took this to mean that the peacekeepers could not be cholera's source. But this view does not take into account the frequency of asymptomatic cholera cases as well as false negatives. Katz goes on to explain: “The tests were taken from leaking water and an underground waste container at the base a week after the epidemic was first noted and processed at a lab in the neighboring Dominican Republic, UN spokesman Vincenzo Pugliese said. Mekalanos said that it is extremely difficult to accurately isolate cholera in environmental samples and that false negatives are common. The Nepalese troops were not tested for cholera before their deployment if they did not present symptoms. But health officials say 75 percent of people infected with cholera bacteria do not show symptoms and can still pass on the disease for weeks.” Katz. “UN Worries Its Troops Caused Cholera in Haiti.”

17
World Health Organization. “Cholera Vaccines: WHO Position Paper.”
Wkly Epidemiol Rec
85 (2010): 118.

18
Ivan Watson. “Medical Group Blasts ‘Inadequate' Response to Haiti Cholera Outbreak.”
CNN
(November 19, 2010). Available: http://articles.cnn.com:/2010-11-19/world/haiti.cholera_1_haiti-cholera-outbreak-peacekeepers-nepal?_s=PM WORLD (accessed April 15, 2011).

19
Ibid.

20
Katz. “UN Worries Its Troops Caused Cholera in Haiti.”

21
Watson. “Medical Group Blasts ‘Inadequate' Response to Haiti Cholera Outbreak.”

22
C. S. Chin et al. “The Origin of the Haitian Cholera Outbreak Strain.”
New England Journal of Medicine
164 (2011): 1.

23
See, for example, Richard Knox. “Cholera Vaccine Isn't the Answer for Haiti.”
NPR
(October 28, 2010). Available:
http://www.npr.org/blogs/health/2010/10/28/130884642/why-the-cholera-vaccine-isn-t-the-answer-for-haiti
(accessed April 15, 2011).

24
U.S. Centers for Disease Control and Prevention.
Update: cholera outbreak—Haiti 2010.
(December 8, 2010). Available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5948a4.htm
(accessed April 15, 2011).

25
See Partners In Health. “Curbing Cervical Cancer in Haiti.”
Partners In Health Bulletin
(August 27, 2010). Available:
http://www.pih.org/news/entry/curbing-cervical-cancer-in-haiti/
(accessed April 15, 2011).

26
A project at the National Penitentiary of Port-au-Prince found that providing antibiotics (along with potable water, soap, and sanitation services) to prisoners sharing living quarters with others with confirmed cholera helped to reduce incidence within the institution. See May J., Joseph P., Pape J., Binswanger I. “Healthcare for Prisoners in Haiti,”
Ann Intern Med.
153 (2010): 407–410.

27
Jeff Sachs. “The Fire This Time Was US-Fueled.”
Taipei Times
(March 1, 2009). Available:
http://www.taipeitimes.com/News/editorials/archives/2004/03/01/2003100742/3
(accessed April 15, 2011).

28
Ingrid Arnesen and Betsey Mckay. “Cholera Spreading in Haiti Faster than Thought.”
Wall Street Journal
(November 25, 2010). Available: http://online.wsj.com /article/SB10001424052748703572404575635533532154818.html (accessed April 15, 2011).

29
Some studies also indicate that the proportion of severe cases may be underestimated in El Tor epidemics. See, for example, K. Bart et al. “Seroepidemiologic Studies During a Simultaneous Epidemic of Infection with El Tor Ogawa and Classical Inaba
Vibrio cholerae
.”
Journal of Infectious Diseases
121 (1970): 17–24. This paper compares the spectrum of illness for El Tor and classic biotype strains of
Vibrio cholerae.
The classic biotype produced a lower proportion of asymptomatic infections (59% vs. 75%) and a higher proportion of severe infections (11% vs. 2%) than the El Tor biotype. Some have hypothesized that the spectrum of variant El Tor biotype strains with classic toxin type would more closely resemble that of the classic biotype, though evidence is anecdotal to date.

30
See L. Ivers et al. “Five Complementary Interventions to Slow Cholera: Haiti.”
Lancet
376 (2010): 2048–2051; D. Walton and L. Ivers. “Responding to Cholera in Post-Earthquake Haiti
.
”
New England Journal of Medicine
364 (2011): 3–5, published online on December 9, 2010.

31
Don McNeil. “Use of Cholera Vaccine in Haiti Is Now Viewed as Viable.”
New York Times
(December 10, 2010).

32
Ibid.

33
Paul Farmer and Jean-Renold Réjouit. “How We Can Stop Cholera in Haiti.”
Newsweek
(November 20, 2010).

34
In Press:
PLoS Neglected Tropical Diseases:
e1145. (2011) doi: 10.1371/ journal.pntd.0001145

35
OCHA Cholera Situation Report # 33 (January 21, 2011). Available:
http://www.reliefweb.int/rw/rwb.nsf/db900SID/MCOI-8DDCXY?OpenDocument
(accessed April 15, 2011).

36
R. Tuite et al. “Cholera Epidemic in Haiti, 2010: Using a Transmission Model to Explain Spatial Spread of Disease and Identify Optimal Control Interventions.”
Annals of Internal Medicine
(March 7, 2011).

37
J. Andrews et al. “Transmission Dynamics and Control of Cholera in Haiti: An Epidemic Model.”
Lancet
(March 16, 2011), DOI: 10.1016/S0140-6736(11)60273-0.

38
Unni Karunakara. “Haiti: Where AidFailed.”
Guardian
(December 28, 2010). Available:
http://www.guardian.co.uk/commentisfree/2010/dec/28/haiti-choleraearthquake-aid-agencies-failure
(accessed April 15, 2011).

39
Jonathan Katz. “Six Killed in Sept. 24 Rainstorm in Port-au-Prince.” Associated Press (September 24, 2010). Available: http://canadahaitiaction.ca /content/six-killed-sept-24-rainstorm-port-au-prince (accessed April 15, 2011).

40
For a summary of Kouchner's trip to Haiti, see “Visit of Bernard Kouchner to Haïti (September 25 and 26, 2010).”
Diplomatie
(September 26, 2010). Available:
http://www.diplomatie.gouv.fr/en/country-files_156/haiti_473/france-andhaiti_2641/political-relations_6180/visit-of-bernard-kouchner-to-haiti-25-26.09.10_14309.html
(accessed April 15, 2011).

41
Deborah Sontag. “In Haiti, Rising Call for Displaced to Go Away.”
New York Times
(October 4, 2010). Available:
http://www.nytimes.com/2010/10/05/world/americas/05haiti.html
(accessed April 15, 2011).

42
There are other reminders, too. In an article titled “Haiti: Humanitarian Crisis or Crisis of Humanitarianism,” Jane Regan points out that a few days before Hurricane Tomas hit the island on November 5, Port-au-Prince's canals—critical drainage arteries—had not yet been cleared.
Huffington Post
(November 5, 2010). Available:
http://www.huffingtonpost.com/jane-regan/haiti---humanitarian-cris_b_779503.html
.

43
Jonathan Katz and Martha Mendoza. “Haiti Still Waiting for Pledged U.S. Aid.” Associated Press (September 29, 2010). Available:
http://www.huffingtonpost.com/2010/09/29/haiti-still-waiting-for-p_n_743002.html
(accessed April 15, 2011).

44
See Ma. Rizza Leonzon. “Bureaucracy Delays US Aid for Haiti Reconstruction.”
Devex
(September 29, 2010). Available:
http://www.devex.com/en/blogs/the-development-newswire/us-aid-pledge-for-haiti-stalled-by-bureaucray-ap-says
(accessed April 15, 2011). See also Jonathan Katz and Martha Mendoza. “Another Obstacle Stalls $1.15 Billion in U.S. Aid to Haiti.” Associated Press (November 6, 2010). Available: http://finance.yahoo.com/news/Another-obstacle-stalls-115B-apf-3649074743. html?x=0 (accessed April 15, 2011). A number of Republican senators, led by Tom Coburn of Oklahoma, raised concerns about corruption, stalling the money for months. The authors report, “President Barack Obama wasn't able to sign the appropriations bill containing the money until July 29. A subsequent bill to authorize release of the funds stalled, and it took until September 20 for the Obama administration to submit a spending plan in an attempt to free up the money.”